Self-rated health

Self-rated health

LASA filenames:
LASA036 (self-rated health),
LASA602, LASA702 (self-rated health)
LASA113, LASA313 (GHPQ)

Contact: Dorly Deeg

Background
A simple and pragmatic tool to measure overall health status is the single item measure of self-rated health (SRH) 1. SRH reflects an individual’s own evaluation of his or her health status and is closely related to well-being and quality of life 2. SRH has been included in sociological and epidemiological studies since the 1950s3, but gained interest in particular after it was identified as a predictor of mortality4. Many studies confirmed this finding, even when mortality-relevant indicators such as gender, socio-economic status and more objective measures of health were taken into account5. SRH also predicts other negative health outcomes, such as hospitalisation, disability and the onset of chronic diseases6-8. The WHO includes SRH in the World Health Survey9, for monitoring the health of populations and outcomes associated with the investment in health systems. SRH has also been recommended as an indicator for healthy life expectancy (i.e. the number of years a person is expected to live in good health)10 and has been described as a useful concept in prevention and clinical medicine2.

The single question is used in various wordings and response formats. Most widely used, and adopted by the Netherlands Health Interview Survey of Statistics Netherlands 11, is the question on the perception of health in general. An individual’s response to this questions, however, depends on this individual’s norms and standards about what constitutes (good) health. Because this standard is not explicit in the general health question, it may be useful to include a standard in the wording of the question. There are various options to do this: comparison with age peers or comparison with one’s own health as it was 5 or 10 years ago.

Limitations of a single question are the likelihood of chance fluctuations in responses, and the limited response range. In longitudinal research, a single question would not be very sensitive to (relevant) change12. To determine perceptions of health that circumvent these limitations, a scale has been developed by the RAND corporation in the United States: the General Health Perception Questionnaire (GHPQ) 13,14. This scale has been translated into Dutch (Vragenlijst Algemene Gezondheidsbeleving, VAGB) and validated for the Dutch situation by LASA researchers 15.

Measurement instruments in LASA
Self-rated health in the LASA main interview is evaluated using two questions, taken from the Netherlands Health Interview Survey: the perception of one’s health in general and the perception of one’s health in comparison with age peers16 . There are five response categories: from (1) ‘excellent’ to (5) ‘poor’, and from (1) ‘much better’ to (5) ‘much worse’, respectively. Also, These responses can be dichotomized, which is often done between (2) and (3), i.e. between ‘excellent or good’ and ‘less than good’, and between ‘(much) better’ and ‘equally good or worse’, respectively 16,17. The two items are moderately to strongly correlated (r = 0.43 in LASA-B) and thus might be used as one sum score. However, this has not been done in other studies. The test-retest reliability, as calculated from the preceding LSN-cycle and the first LASA-cycle (time interval: 10 months), are 0.75 and 0.67, respectively.

In 2005, at the F measurement, the question ‘how is your health compared to 3 or 4 years ago’ was added. This was done to measure a possible response shift 18 in self-rated health since the previous measurement. Incongruence between response to this question and the true response at the previous measurement is indicative of a response shift 19.

In the self-administered LASA questionnaire, an abbreviated version of the GHPQ is included (General Health Perceptions Questionnaire) 13,14. This version consists of eight questions, four about current health perception, and four about the expectation of future health. The reliability of this version of the scale as a whole, based on the first LASA cycle, and evaluated using Cronbach’s alpha, is 0.78. The two subscales have a reliability of 0.73 (current) and 0.63 (future; item 3 omitted to obtain a better scale), respectively.

Questionnaires
LASAB036 / LASAC036 / LASAD036 / LASAE036 / LAS2B036 / LASAF036 / LASAG036 / LASAH036 / LAS3B036 / LASMB036 / LASAI036 / LASAJ036 / LASAK036 (main interview, in Dutch);
LASAB113 / LASAC113 / LASAD113 / LASAE113 / LAS2B113 / LASAF113 / LASAG113 / LASAH113 / LAS3B113 (self-administered questionnaire, in Dutch);
LASAC602 / LASAD602 / LASAE602 / LASAF602 / LASAG602 / LASAH602 / LASAI602 / LASAJ602 / LASAK602  (telephone interview with proxy, in Dutch);
LASAC702 / LASAD702 / LASAE702 / LASAF702 / LASAG702 / LASAH702 / LASAI702 / LASAJ702 / LASAK702 (telephone interview with respondent, in Dutch)

Variable information
Information about names, labels, and values formats of variables used in LASA:
LASAB036 / LASAC036 / LASAD036 / LASAE036 / LAS2B036 / LASAF036 / LASAG036 / LASAH036 / LAS3B036 / LASMB036 / LASAI036 / LASAJ036 / LASAK036
(pdf);
LASAB113 / LASAC113 / LASAD113 / LASAE113 / LAS2B113 / LASAF113 / LASAG113 / LASAH113 / LAS3B113;
LASAB313 / LASAC313 / LASAD313 / LASAE313 / LAS2B313 / LASAF313 / LASAG313 / LASAH313 / LAS3B313 (scale values)
(pdf);
LASAC602 / LASAD602 / LASAE602 / LASAF602 / LASAG602 / LASAH602 / LASAI602 / LASAJ602 / LASAK602
(pdf);
LASAC702 / LASAD702 / LASAE702 / LASAF702 / LASAG702 / LASAH702 / LASAI702 / LASAJ702 / LASAK702
(pdf)

Availability of information per wave ¹

¹ More information about the LASA data collection waves is available here

* 2B=baseline second cohort;
3B=baseline third cohort;
MB=migrants: baseline first cohort

Ma=data collected in main interview;
Sa=data collected in self-administered questionnaire;
Tr=data collected in telephone interview with respondent;
Tp=data collected in telephone interview with proxy

Previous use in LASA

Recommendations for the use of self-rated health in studies on ageing can be found here:

• Galenkamp H, Braam AW, Huisman M, Deeg DJH. Self-rated health: when and how to use it in epidemiological studies among older people? OA Epidemiology, 2014.

Other studies on self-rated health in LASA:

• Deeg, D.J.H., Kriegsman, D.M.W. (2003). Concepts of self-rated health: Specifying the gender difference in mortality risk. Gerontologist, 43, 3, 376-386.
• Galenkamp-van der Ploeg, H. Feeling healthy versus being healthy: change and stability in older people’s self-rated health. VU University (2013).
• Van de Kamp, K., Braam, A.W., Deeg, D.J.H. (2008). Verschuiving van de ervaren gezondheid van 55-64-jarigen tussen 1992/1993 en 2002/2003. Verklarende factoren. [Shift in the self-perceived health of 55-64-year olds between 1992 and 2002]. Tijdschrift voor Gerontologie en Geriatrie, 39, 182-192.
• Parkatti, T., Deeg, D.J.H., Bosscher, R.J., Launer, L.J. (1998). Physical activity and self-rated health among 55- to 89-year-old Dutch people. Journal of Aging & Health, 10, 311-326.
• Rijs, K.J., Cozijnsen, M.R., Deeg, D.J.H. (2012). The effect of retirement and age at retirement on self-perceived health after three years of follow-up in Dutch 55-64-years-olds. Ageing & Society, 32, 281-306.

References

1. Jylhä M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med 2009;69(3):307-316.
2. Fayers PM, Sprangers MAG. Understanding self-rated health. Lancet 2002;359(9302):187-188.
3. Suchman, E.A., Phillips, B.S., Streib, G.F. An analysis of the validity of health questionnaires. Social Forces 1958; 36:223-232.
4. Mossey JM, Shapiro E. Self-rated health: a predictor of mortality among the elderly. Am J Public Health 1982;72(8):800-808.
5. Idler, E.L., Benyamini, Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 1997; 38(1):21-37.
6. Menec VH, Chipperfield JG. A prospective analysis of the relation between self-rated health and health care use among elderly Canadians. Canadian Journal on Aging-Revue Canadienne du Vieillissement 2001;20(3):293-306.
7. Idler, E.L., Kasl, S.V. Self-ratings of health – Do they also predict change in functional ability. Journals of Gerontology Series B-Psychological Sciences and Social Sciences 1995; 50(6):S344-S353.
8. Latham, K., Peek, C.W. Self-Rated Health and Morbidity Onset Among Late Midlife U.S. Adults. J Gerontol B Psychol Sci Soc Sci 2012.
9. World Health Organization, Statistics Netherlands. Health interview surveys: Towards international harmonization of methods and instruments.  1996. Copenhagen, WHO Office for Europe.
10. Robine, J.M., Jagger, C. Creating a coherent set of indicators to monitor health across Europe: the Euro-REVES 2 project. Eur J Public Health 2003; 13(suppl 3):6-14.
11. Netherlands Central Bureau of Statistics (NCBS). Vademecum gezond­heidssta­tistiek Nederland 1995 [Vademecum health statistics The Netherlands 1995]. Voor­burg/Heerlen/Rijswijk: NCBS/Ministry of Health, Welfare and Sport, 1995.
12. Galenkamp-van der Ploeg, H. Feeling healthy versus being healthy: change and stability in older people’s self-rated health. VU University (2013).
13. Brook RH, Ware JE, Davies-Avery A, et al. Overview of adult health status measures fielded in RAND’s Health Insurance Study. Medical Care 1979; 17(suppl): 1-131.
14. König-Zahn C, Fürer JW, Tax B. Het meten van de gezondheids­toestand: beschrij­ving en evaluatie van vragenlijsten. 1. Algemene gezondheid [The measurement of health status: description and evaluation of questionnaires. 1. General health]. Assen: Van Gorcum, 1993.
15. Kriegsman DMW, Eijk JTM van, Deeg DJH. Psychometrische eigenschappen van de Nederlandse versie van de RAND General Health Perceptions Questionnaire. De vragenlijst Algemene Gezondheidsbelevering (VAGB). [Psychometric properties of the RAND General Health Per­ception Ques­tion­naire in the Neth­erlands.] Tijd­schrift Sociale Ge­zondheids­zorg 1995; 73/6: 390-398.
16. Deeg DJH. Ervaren gezondheid verschilt naar tijd en plaats [Self-rated health differs across time and place]. In: Broese van Groenou MI, Deeg DJH, Knipscheer CPM, Ligthart GJ (eds). VU-Visies op Veroudering [VU-visions on aging]. Amsterdam: Thela Thesis, 1998, pp. 131-136.
17. Galenkamp, H., Braam, A. W., Huisman, M., & Deeg, D. J. (2011). Somatic multimorbidity and self-rated health in the older population. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 66(3), 380-386.
18. Sprangers MAG. Integrating response shift into health-related quality of life research: a theoretical model. Social Science & Medicine 48, 1999: 1507-1515.
19. Galenkamp, H., Huisman, M., Braam, A. W., & Deeg, D. J. (2012). Estimates of prospective change in self-rated health in older people were biased owing to potential recalibration response shift. Journal of clinical epidemiology, 65(9), 978-988.

Date of last update: April 14, 2020 (ET)